Provider Demographics
NPI:1144771098
Name:MCBLACKKY TRANSPORT, LLC
Entity Type:Organization
Organization Name:MCBLACKKY TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEBOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-422-3929
Mailing Address - Street 1:9001 MARKVILLE DR
Mailing Address - Street 2:#1111
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-9341
Mailing Address - Country:US
Mailing Address - Phone:214-422-3929
Mailing Address - Fax:
Practice Address - Street 1:9001 MARKVILLE DR
Practice Address - Street 2:#1111
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-9341
Practice Address - Country:US
Practice Address - Phone:214-422-3929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-16
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)